Complications of Hiatus Hernia

THE recognition of esophageal hiatus hernia as a pathologic entity is more widespread than might be anticipated. The impetus to diagnosis and clinical evaluation may be attributed primarily to the efforts of the roentgenologists. Careful study of the terminal esophagus and cardiac portion of the stomach is an integral part of every complete gastrointestinal study. For these reasons the incidence of hiatus hernia appears to be on the increase each year. Actually it is the incidence of recognition that is on the increase rather than the entity proper.

Hiatus hernia may be an incapacitating condition but is rarely a fatal one. The most troublesome complications of hiatus hernia are from bleeding, occult or massive. Peptic ulcers may occur and produce the disabling symptoms seen in ulcers elsewhere. Apparently perforation of an ulcer in a hiatus hernia is a rare entity as is strangulation of the incarcerated portion of the stomach.

In patients with esophageal hiatus hernia the stomach usually protrudes from the celomic cavity into the posterior mediastinum. This extension of the retroperitoneal portion of the stomach through the hiatus classifies this entity as a sliding hernia. A sac is also present since the reflection of the peritoneum on the anterior wall of the stomach is drawn through the hiatus by the herniated viscus. The recognition of this type of herniation is important in its surgical repair. Whereas inguinal sliding hernias descend externally into the scrotum, the hiatus hernia enters the posterior mediastinum and there causes compression or displacement of. . .